Election Ushers in Home Care Minimum Wage Hikes

In what has been described as a stunning set of results, America’s election decided a heck of a lot more than selecting the nation’s next president. It also brought forth a wave of minimum wage increases at the state level that will impact home care businesses and workers.

Specifically, four states decided to raise minimum wage rates through ballot measures—Arizona, Colorado, Maine and Washington. The move comes after the nationwide movement for higher wages, dubbed the Fight for $15, has gained significant momentum since its inception nearly four years ago.

Since then, roughly 22 million workers have seen raises, with 10 million guaranteed a path to $15 per hour, according to the Fight for $15 organization. Members and advocates of the movement include workers from the fast food industry, airports, child care, home care and more.

Covering Rising Labor Costs

Home health care and home care companies have already been impacted in states where the minimum wage has been raised to $15 per hour, including California and New York. One California home care provider even had to branch out into other service lines by adding a senior living component to his business after he estimated a 30% drop in business after raising prices due to minimum wage hikes in the state. Other providers have turned to cutting hours and similarly increasing their rates.

For home care providers that rely on federal and state payors, increasing wages can’t be offset by raising rates on patients. And reimbursement rates aren’t keeping up with rising labor costs.

“While I know every provider would like to pay their workers more, our state reimbursement rates (Medicaid/state funded programs) have been stagnant for nearly 15 years,” Vicki Sebell, executive director of Home Care & Hospice Alliance of Maine, told Home Health Care News. “I feel strongly that when the states (government) increase costs for providers, the providers should be adequately reimbursed, especially if 100% of the care delivered by the agency is government funded. Then, their reimbursement should reflect the added costs of doing business. We aren’t LL Bean, where you can simply raise the price of hunting boots or flannel shirts to cover your losses.”

In Maine, the minimum wage will rise to $9 per hour in 2017, up from the current $7.50 per hour, with escalators in place up to $12 per hour by 2020 and further increases at the same rate of cost of living. Portland, Maine, approved an even higher wage level, which means some agencies have to pay multiple wage rates, depending on which municipality their workers provide services.

Rising minimum wage rates in different areas of a state have forced some businesses to raise rates for some services across the board. For example, sick and safe leave benefits, as well as higher wages, were granted in Seattle before the rest of the Washington state. Ballot measures approved on Nov. 8 will increase the minimum wage to $13.50 in Washington state by 2020.

“The biggest impact is on the live-in rate,” Susan “Sam” Miller, CEO and co-owner of Lynnwood, Washington-based CareForce, Inc., told HHCN. “There was a time when live-in could compete with assisted living and/or skilled nursing. In combination with the elimination of the companion exemption and the increase in minimum wage beginning next year, I am pretty sure that most people will be priced out of the live-in market.”

The higher wages in one city have pushed prices up across the state so businesses can offset their costs and stay competitive in a tightening labor market.

“In addition, we, for the last two years, had two prices for live-in—one in Seattle proper and one outside of Seattle,” Miller said. “But pressure from caregiver shortages is forcing us to move to one price which will follow the Seattle minimum wage scale.”

Looking Ahead

While the election may have illuminated steep partisan lines across the country, some in home care are feeling optimistic about opportunities to work with elected officials.

“Fortunately, we work well with all elected officials—perhaps because we belong to the ‘Home Care Party’,” Donna DeBlois, president and CEO of MaineHealth Care at Home, told HHCN. “The need for home care services has no party lines.”

Both the Democratic and Republican parties singled out home care within the national platforms during the campaign season. A home care worker was even a featured speaker at the Democratic National Convention, where she spoke about her advocacy work for a living wage.

Fight for $15 has organized a national protest on November 29—the movement’s four-year anniversary— with plans for fast food, airport, child care and home care workers to engage in civil disobedience across the nation. Workers involved are demanding a $15 hourly wage, in addition to union rights. The organization has also highlighted the need for justice for minorities and immigrants in the wake of heightened immigration scrutiny in the aftermath of the election.

“In all, tens of thousands from coast to coast will protest Nov. 29 to underscore to the country’s biggest corporations that they must act decisively to raise pay for fast-food, airport, home care, child care and higher education workers, among others, and to let President-elect Donald Trump, members of Congress, governors, state legislators and other elected leaders know that the 64 million Americans paid less than $15/hour are not backing off their demand for $15/hour and union rights,” the group proclaimed when announcing the day of civil disobedience.

Association groups, including the National Association for Home Care & Hospice (NAHC), have fought hard against overtime rules and increases to minimum wage around the country. Most notably, the organization took the recent decision by the Department of Labor (DOL) to guarantee minimum wage and overtime protections to home care workers all the way to the Supreme Court. The rule took effect in 2015.

With the outcome of the nation’s presidential election put to bed, the new administration rolling into the nation’s capital affords opportunities for many industries. One key campaign promise of President-elect Donald Trump to cut regulations could spell good news for the home health care and hospice industries, which have faced an onslaught of new requirements over the past several years.

From the Pre-claim Review Demonstration from the Centers for Medicare & Medicaid Services (CMS) to the elimination of the overtime exemption rule, the home health and home care industry has seen major changes that have impacted the way businesses run.

Leaders from the National Association for Home Care & Hospice (NAHC) are eyeing big opportunities to roll back burdensome regulations with the incoming administration and new members of Congress, they said during a teleconference this week on the impact of the election results. At the same time, the industry group is weighing the risks of overturning some of the biggest reforms to the health care system.

Regulatory Rollback Opportunities

“There’s a great opportunity to revisit a number of rules,” Bill Dombi, NAHC’s vice president for law, said during the web event Tuesday. “At the top our list is the face-to-face requirements, along with the pre-claim review action that came out of CMS.”

NAHC has already indicated it will move forward with a lawsuit to challenge the pre-claim review demonstration in Illinois and the four other states it will likely be implemented in. The group is “bullish” on its ability to work with the new administration and Republican majority in Congress to push back against the program.

In regards to the face-to-face requirements, NAHC is seeking rollbacks on the documentation process and has long supported legislation that would enable nurse practitioners to sign off on home health care plans in addition to physicians.

“Why we see great opportunity with the new Congress and administration [is because] we have strong Republican support for a legislative effort to modify the regulatory elements,” Dombi said. “With a new CMS administration, Health and Human Services (HHS) secretary, and others, we hope we can get them to back off the onerous documentation requirements.”

However, the changes are not likely to happen overnight.

“I myself am optimistic,” Dombi said. “Let me temper that with the nearly 5,000 jobs that President-elect Trump has to fill in agencies from secretaries on down. The turnover on leadership will make the changes not happen right away.”

Fortunately, some potential candidates being considered for administrative positions are already allies of NAHC, and executives said they could be “smiling” at some of the opportunities to work with new leadership in the health care agencies.

The Risk of Repeal

With all the opportunities, there are still many unknowns. One of the most significant campaign promises from President-elect Trump was to repeal and replace the Affordable Care Act (ACA). Republicans in both houses of Congress have similarly put forth great effort to overturn the heath care reform law, with at least 52 tries to repeal it, in part or in full.

Yet, repealing the ACA in full leaves the health insurance of 20 million Americans who have signed up for coverage under the new reforms up in the air. Neither Republicans nor Donald Trump have put forth an “adequate” replacement plan that would account for those 20 million Americans’ coverage, according to Prue Fitzpatrick, vice president for government affairs at NAHC.

“It will will be interesting to see how a campaign slogan translates into actually governing without taking health care away from 20 million Americans,” Fitzpatrick said during the panel discussion. “It’s difficult [to repeal] since the ACA and health care system at large has so many components to it.”

The best health care plan to analyze in terms of what might replace the ACA is Paul Ryan’s “Better Way” plan, NAHC executives say. Yet even that plan doesn’t provide a complete explanation for those currently covered under ACA insurance offerings.

In the last week since the election, Donald Trump also appears to be “softening” about his position of repealing the ACA. During a recent interview with CBS’ 60 Minutes, Trump explained that he would be open to keeping certain parts of the health care law, including keeping young people on their parents’ insurance plans until the age of 26 and requiring insurance companies not turn away those with pre-existing conditions.

Furthermore, general concepts of the ACA, like shifting the health care system away from fee-for-service toward value-based purchasing, are likely to remain in place. Home health, as a setting with a lower cost of care, stands to benefit from this shift.

Furthermore, the process of repealing the law in the Senate could prove difficult, with Republicans only having secured 52 seats in their majority. To sweep the Senate, the party would need a 60-vote majority. Though, there are steps the Republicans could take to undo the ACA in the Senate.

Repealing parts of the ACA that are more broadly supported, including the employer mandate that require businesses of a certain size to offer health insurance coverage to employees, are supported by NAHC. Dismantling that requirement would benefit NAHC’s home care, home health and hospice members, leaders said Tuesday.

Looking ahead, NAHC is ready to act on the regulatory opportunities with the new administration and leadership across governmental agencies.

“No matter what anyone’s position is, step back and look at the tremendous opportunity on the regulatory side and industry side,” said Fitzpatrick. “It doesn’t mater what party is in power, there are a lot of good minds in Washington looking to lower cost of care and looking at quality of outcomes.”

Aging seniors and their families are often confounded by the complexity of issues facing the elderly (including declining income, increased debt, poor investment returns, declining health, medical crises, complex insurance programs, long term care challenges, etc…). This book (published in 2014) takes a comprehensive approach to address these challenges and provide solutions.

Treating Medical Problems

Lack of Proper Care

Below is a list of common medical conditions the elderly deal with. These are also conditions that may occur in younger people but some of them such as cataracts, congestive heart failure, chronic obstructive pulmonary disease, osteoporosis, diabetes, stroke, incontinence, dementia, and prostate problems are more unique to an older generation. Remember also that many of these conditions may coexist together in the older person.

Cancer

Hypertension

Cardiovascular Disease

Congestive Heart Failure

Cataracts

Pneumonia

Chronic Obstructive Pulmonary Disease

Back Pain

Lack of Strength

Eye Problems

Osteoarthritis

Rheumatoid Arthritis

Other Immune Disorders

Osteoporosis

Parkinson's Disease

Dementia

Problems of the Prostate Gland

Depression

Diabetes

Stroke

Urinary Incontinence

Older Americans account for over one third of all medical spending in this country — approximately $300 billion a year for their share of the cost. It costs about four times the amount of dollars to treat a 65 year old for health care in a given year than it does to treat a 40 year old. Even though people age 65 and older have their own health care insurance, called Medicare, Medicare simply pays the bills and up to this point has not been actively involved in promoting a better delivery system for this age group. Recently there has been much talk of Medicare supporting preventative, outcome based medicine but aside from a few minor changes little has been done. However, there is a possible change on the horizon. Medicare is currently conducting a test program and evaluating a number of hospitals for their outcome of care with patients. Instead of determining the wellness of patients by treatment protocols or medications the program is trying to identify hospitals that are more successful than others in having positive medical treatment outcomes. The intent is to reward these hospitals with a 20% bonus in Medicare reimbursements. Hospitals that are below average in meeting the standards will receive a 2% reduction in reimbursements.

Hospital admissions for the elderly are about three times those for the young. Older Americans visit a health provider at least twice as often as younger Americans. And Americans 75 years and older use hospital emergency rooms about twice as often as any other age group. With a different approach, Medicare could probably reduce older Americans' number of office visits, hospital admissions and emergency room visits.

All doctors are certainly aware of the differences in medical problems of the young and of the old. What doctors, who do not regularly treat the elderly, are not usually aware of is the fact that older people often have multiple problems at the same time and symptoms from one may be misleading or mask symptoms from the other. Consider the example above of the lady with low thyroid, malnutrition and depression. Her health care providers failed to test for or even recognize these combinations and the interplay they had on worsening her depression. They even misdiagnosed her depression as age-related dementia.

It is not to say that the healthcare profession does not treat the elderly aggressively for medical conditions that are diagnosed. The problem seems to lie with an undue focus on correcting specific problems and ignoring the underlying social, nutritional, psychological and physical activity components of an older person's health. As we have discussed previously, these components have a tremendous influence on the health of senior citizens. This is less true for younger people. Younger people are already active, socially stimulated and pursuing careers. Most healthcare practitioners don't recognize this difference and they treat the older patients only for their conditions assuming they will respond just like their younger patients. Once they have been treated many doctors, especially specialists, go on to taking care of a multitude of other patients and are unlikely to follow up over a long period with their older patients. And those practitioners who do want to provide follow-up are only reimbursed under Medicare if they can find an excuse for an office visit that doesn't include just a routine exam.

A Holistic Treatment Approach
Most practitioners who specialize in care for the elderly are aware of the above-mentioned problem with older patients and they take a holistic approach with the medical treatment of these people. An attempt is made not only to treat the specific condition or conditions but to make sure there are sufficient activity, proper nutrition and family support at home. They work closely with family members to make sure their loved ones are taking medications properly and are reporting their symptoms. They require those caring for the elderly to closely monitor health conditions and report any changes before things get worse. They meet with their patients regularly enough to monitor their health. This broad-based approach results in better health and in fewer visits to the emergency room because intervention for a worsening condition is achieved at an earlier stage.

A good example of this holistic approach is the Veterans Administration health care system. The VA system over the years has become the nation's largest geriatric care provider for older men. Almost all veterans are men and because most veterans hearken back to World War II, the Korean conflict and the Vietnam War most of them are older than age 60. Because of this the VA has found it necessary to adapt its health-care to this age group. The VA schedules regular exams at least every six months or yearly depending on available funds and personnel. A health examination always includes lab work. Screenings for cancer, cardiovascular problems, eye problems, hearing problems and many other conditions common to aging are a routine part of veteran's administration health-care. The VA was one of the first health providers in the nation to require its local hospitals to keep their records on computer and in a central database. This allows health practitioners in the system to quickly and efficiently access all information and avoid misdiagnoses and possible drug interactions. By taking a hands-on, preventative approach to the treatment of older men the system is able to keep its patrons healthier and avoid costly medical interventions due to lack of follow-up.

A significant problem with providing holistic treatment is many health insurance providers, including Medicare, will not pay for routine office visits without an underlying medical complaint. Some private health plans are starting to use so-called "pay for performance" or "outcome based care" where the overall health of the patient takes precedence over the procedures used to get there. But Medicare, up to this point, has not made this change. This makes it extremely difficult for the geriatric care provider to monitor his patients and intervene before a health problem becomes bad enough to require hospitalization or major surgery. Doctors practicing this type of medicine have to be inventive in order to provide adequate treatment. Family of the elderly can also help in this respect by "finding" medical complaints to justify setting regular appointments with the doctor.

Treatment of Depression
Older Americans have a suicide rate that is four times the national average. Much of this is a result of depression. It is estimated that 20% of the aging population suffers from depression. Practitioners not trained in geriatric care automatically assume that depression is a normal part of the aging process. This is not true. Depression can be treated just as effectively in older people as it is in younger people. But sometimes medications are not as effective in older people as they are in a younger population. Unfortunately, practitioners often rely too heavily on medications and don't try other non-medical therapies.

Many doctors simply don't choose to recognize depression and help their older patients with it. It is interesting to note that over 70% of elderly suicide victims committed suicide within one month of seeing their health care practitioner. Many of these people were not referred or treated for depression by that health care practitioner.

The Problem with the Nursing Home Care Model
Nursing homes serve two purposes. The first is to provide nursing and medical care for people recovering from illness or injury. The intent is to get these people well and return them back into the community. A second purpose for the nursing home is to care for people who have severe chronic medical or cognitive impairments and who are not expected to recover but only to get worse. These are often called long-term care residents. Rehabilitation patients and long-term care residents are typically segregated in different parts of a nursing home. Or it is often the case a nursing home will specialize only in rehabilitation or long-term care but not both.

The general attitude towards long-term care residents is they will never recover and will either die in the nursing home or be transferred to a hospital to die. Some might argue this is reality but it is also age discrimination. As we have seen in previous examples, sometimes long-term care residents are misdiagnosed or given improper medications which may make them candidates for long-term care but they may also respond to treatment and even recovery and as we saw in one example could even return home and lead a normal life. But because of the prevalent attitude towards "warehousing" long-term care residents, most nursing homes do little to try and rehabilitate these people other than treating acute conditions and making them comfortable.

Another problem is these people are typically receiving assistance from Medicaid or Medicare. These government programs only pay nursing homes to provide treatment such as dispensing medications, providing assistance with activities of daily living, treating medical conditions or giving psychiatric help. Nursing homes are not reimbursed for alternative therapies that might make patients better. Another problem is often the doctor assigned to the patient either has little interest in providing therapies to facilitate recovery or the doctor is inexperienced in geriatric care.

Unfortunately, another reason for not being more actively involved with residents is that many nursing homes in the country have large numbers of unoccupied beds. It is not in their best interest to cure a resident and return him or her to another living arrangement as that would result in a loss of revenue and there are no people standing in line to occupy the vacant bed.

This attitude in nursing homes becomes an age discrimination issue. The elderly are treated differently from other age groups. There are a small number of US nursing homes that don't rely on government reimbursement, are not concerned about occupancy rates and are free to use alternative approaches. Some of these facilities have been successful, in a number of cases, in improving the condition of their long-term care residents and allowing them to return to a community living arrangement. They typically use approaches we have already discussed such as involving residents in their own medical decisions, providing pets and plants, providing interaction with children, stressing activity and mental stimulation and in aggressively following up and properly treating medical conditions. This approach is often called "the holistic approach" to nursing home care.

About Medical Care for The Elderly

Aging seniors and their families are often confounded by the complexity of issues facing the elderly (including declining income, increased debt, poor investment returns, declining health, medical crises, complex insurance programs, long term care challenges, etc…). This book (published in 2014) takes a comprehensive approach to address these challenges and provide solutions.

The American Perspective on Aging and Health

American society in general glorifies youth and fears or even despises old age. This is not the case in many other societies where age is associated with wisdom, knowledge and special status.

We see evidence of this bias towards older Americans especially in the media. In films and on TV old people are very often depicted as weak, indecisive, bumbling or even comic. We laugh at their misdeeds and forgive their mistakes knowing in the back of our minds that they are old and can't help themselves. We view them not as capable as younger people. It is rarely that we see older people depicted as decisive, strong or as leaders. We see this same attitude with large corporations and government employers. At a certain age, employees are encouraged or expected to "retire" to a new phase of their lives where they are not required to work for a living any longer. Retirement is presumably a reward for many years of dedication and hard work, but the underlying philosophy is more likely based on the idea that older workers are no longer productive or useful.

As Americans age we fear the deterioration of our bodies and the possible lack of security due to low income — a byproduct of old-age. Some people in our country fight old age through cosmetic surgery, use of supplements, aggressive weight-loss programs or through overzealous physical training programs. Other people accept old age gracefully and adapt as well as they can. Still others refuse to grow old and resist aging by adopting social strategies such as denial, refusal to participate in life or becoming belligerent. (The angry old codger image)

Instead of taking the role as leaders in their families or in the community as is the case in some countries, the elderly in our country, even after successful careers in earlier years, simply become invisible. They waste their prodigious talents traveling, entertaining, socializing, watching TV or playing golf. They are rarely asked to assume responsible roles in the community. And unlike other cultures, older Americans often abandon themselves to control by other people, often their children and their health care providers. Instead of taking responsibility for their own decisions they will rely on children or others to make decisions for them. Many of them seem to enjoy the role of becoming dependent on others. And it is all too often the case that family and others pander to this submissive role of the elderly and we begin treating them like children.

This generally accepted perception of aging in our country has resulted in the elderly themselves and in the community at large regarding older people as less valuable than younger people. The assumption is that the elderly have lost the ability to think clearly, to learn new things and they are generally incapable of any physical activity other than walking or sitting. This attitude also carries over into the health treatment that older Americans receive.

The Older Person's Attitude towards His or Her Own Health

Many elderly buy into the notion that they themselves are no longer useful and as a result make little attempt to keep themselves healthy and active. After all, they are getting closer to the end of their lives and have no desire to try new things or to challenge themselves or to eat or exercise properly.

There is a great deal of anecdotal and research evidence that demonstrates older people can learn, can retain memory and can be actively involved in business and in the community. The lack of physical exercise, social involvement and mental stimulation in older Americans often leads to these people losing the ability to use their minds and their bodies. The older person's negative attitude towards aging becomes self-fulfilling.

Many reason that they have missed their opportunities in life when they were younger and it's too late to start over. As a result, many older people are intimidated by new ideas or by technology such as computers, not because they are incapable but simply because of their attitude. The idea of not being able to "teach an old dog new tricks" is in most cases an excuse. Obviously this mindset of failure and inability to perform becomes self-fulfilling. Not surprisingly, depression and suicide are more common in the elderly than in the younger population.

The negative attitude towards aging on the part of an older person has a direct impact on that person's health. Many studies show that people who are physically active have less joint pain, lower blood pressure, less depression, fewer heart attacks and a lower incidence of cancer. Proper nutrition also has the same affect on the aging process; it delays the onset of debilitating illness or disability.

According to James S. Marks, M.D., M.P.H., Director of the National Center for Chronic Disease Prevention and Health Promotion

"…. Research has shown that poor health does not have to be an inevitable consequence of growing older. Death is inevitable, but, for many people, it need not be preceded by a slow, painful, and disability- ridden decline. Our nation will continue to age — that we cannot change — but we can delay and in many cases prevent illness and disability."

A study in 2000 from the Journal of the American Geriatric Society reports that inactive women at age 65 have a life expectancy of 12.7 years whereas highly active, non-smoking women at 65 have a life expectancy of 18.4 years. A report from the CDC indicates that very few older Americans get 30 minutes or more exercise for five days a week or more. The report states that up to 34% of adults age 65 to 74 are inactive and up to 44% or almost half of adults age 75 are inactive. A study From the US Preventative Services Task Force reveals that regular exercise can reduce life-threatening falls in the elderly by 58%. Another study showed that regular exercise reduced pain and increased function in joints of older Americans suffering from osteoarthritis. (Reduced the need for pain medications) Yet another study found that strength training was as effective as medication in reducing depressive symptoms in older adults. Other studies from the Department of Health and Human Services support the idea that older people who are responsible for their own health and their own health decisions are healthier than people who rely on others to make decisions for them.

Lack of activity and poor nutrition often lead to obesity. More than any other problem facing older people, obesity can have the worst effect on their health. It leads to joint degeneration, heart problems, stroke, congestive heart failure, diabetes and a whole raft of other chronic medical conditions. And obesity among all ages is becoming a national crisis.

Another health problem with the elderly is the overuse of alcohol, cigarettes and addictive medicines such as pain killers or tranquilizers. It is assumed by the elderly and by their family that long-term use of these substances has gotten to a point where it would be pointless or impossible to get the elder person to discontinue or cut back on their use. In other words older people are no longer useful so let them have their bad ways. "Everyone dies at some point; what does it matter what causes the death." For instance it is assumed that smoking has already done its damage and little could be achieved in stopping. Actually recent evidence indicates that no matter what the age, cessation of smoking can reduce the incidence of chronic lung disorders and improve lung function even after a few weeks.

No one knows the extent of abuse of alcohol or other addictive substances among the elderly simply because no definitive studies have ever been done and older abusers remain hidden and invisible to the public. Again this is reflective of our society's attitude towards the elderly. It is commonly felt, especially by doctors who prescribe addictive medications, that we should,

"Let them have their vices, it gives them comfort and relief from pain and they are old and are going to die anyway".

Because of this public attitude many elderly people waste the remainder of their lives living in alcohol or drug induced stupor. And their health suffers as well due to lack of activity and poor nutrition.

The average 75-year-old suffers from at least three chronic medical conditions and takes five or more medications. Oftentimes older people have resigned themselves to a life of suffering and pain. They are not particularly interested in changing or improving their medical condition but are simply waiting out the rest of their life. These people often exhibit a phenomenon known as "the reluctant patient". They will not listen to medical advice, they have little interest in their own health and they often don't take their medications properly or they overdose. Doctors and other health professionals treating reluctant patients don't get the information they need in terms of symptoms or progression of treatment. The patient will typically lie about his or her condition. It requires a greater understanding from medical professionals and encouragement or sometimes forceful intervention from family to help the reluctant patient understand his or her attitude and participate in his or her medical treatment. The result can often be improved health and a greater quality of life.

Families or others involved with an elderly person must recognize the all too common attitude of worthlessness, defeat and resignation from elderly loved ones and take corrective action. They should encourage and possibly even prod the older person to be stimulated mentally, socially and physically — to be actively involved; to give him or her a purpose for living. But families should also be very careful not to become patronizing or controlling but be genuinely supportive in this process. Here are some ideas.

Make sure an elderly loved one has challenging activities throughout the day instead of simply watching TV or viewing videos. This might include trips to interesting places, visiting senior centers, providing challenging games or puzzles, doing volunteer work, providing an opportunity to be involved in church work, offering stimulating conversation or working on an adult education class or college degree.

If the person is interested, encourage him or her to become involved in handcraft, genealogies, creative design, writing, scrap booking or other challenging home oriented activities.

Give them responsibility for taking care of pets such as a dog, a cat or a friendly bird. In addition, if feasible, allow them to care for plants as well. This strategy is used often in nursing homes to reduce depression in the elderly and to actually improve their health as well. It really works.

If a caregiver for an older person cannot be present, make arrangements to enroll a loved one in adult day care. These providers often offer the same strategies we are talking about here.

Provide opportunities for family and friends to come by and visit and encourage or even arrange such encounters.

Provide opportunities for the older person to interact, teach and nurture children such as grandchildren or children in a day care center. This is an extremely effective strategy for helping the older person feel that he or she has a meaningful existence. And it has a dramatic impact on improving and maintaining health.

Design or arrange an exercise program and come up with a way to encourage the older person to follow it.

Understand the nutrition needs of an older loved one, especially the need for vitamins and minerals including iron. Get some books on the subject or go to the Internet. Make sure the person takes care of him or herself and eats properly. Fixing special meals, providing treats, getting takeout or going out to dinner can be fun and exciting for anyone regardless of age. Many elderly people neglect their own nutrition. Poor nutrition can cause all kinds of mental and physical problems in the elderly.

Make sure an older person has opportunity to look good and have nice clothing. Make sure the person gets out in public, and tries dining out or going to a public event and can feel good about his or her appearance.

Aging and the Attitude of Health Care Providers

It is natural that health care providers such as doctors, pharmacists or nurses will have the same attitude towards aging as other Americans. Without proper geriatric care training, these people can fall into the same trap of treating the elderly differently from younger people. According to the Alliance for Aging Research,

"In recent years evidence has been mounting to suggest that, at all levels in the delivery of healthcare, there is a prevailing bias -ageism – that is at odds with the best interests of older people. This prejudice against the old in American healthcare is evidenced by scores of recent clinical studies, surveys and medical commentaries, many of which are referenced here. In this report, we outline five key dimensions of the ageist bias in which U.S. healthcare fails older Americans:

• Healthcare professionals do not receive enough training in geriatrics to properly care for many older patients.
• Older patients are less likely than younger people to receive preventive care.
• Older patients are less likely to be tested or screened for diseases and other health problems.
• Proven medical interventions for older patients are often ignored, leading to inappropriate or incomplete treatment.
• Older people are consistently excluded from clinical trials, even though they are the largest users of approved drugs."

A fictional story, often used in the training of geriatric physicians, goes this way:

A 90 year old man meets with his doctor and complains about pain in his right knee. The doctor tells him, "Well Henry, what do you expect? You're 90 years old."

Henry replies, "But doctor my left knee is the same age as my right knee, there's no pain and it feels just fine!"

Many in the health-care profession consider old age to be a disease itself. Any medical problems are inappropriately attributed to old age as if it were a medical condition. And since there is no cure for old age, appropriate tests and treatment are never performed. Thus, medical problems that may not be related to age and may just as frequently occur in younger people are often not treated. As an example a recent survey of physicians involved in the health-care of the elderly reported that 35% of the doctors considered hypertension a result of the aging process and that 25% of them felt that treating an 85-year-old for symptoms of hypertension would cause more harm than the benefits it would produce.

Consider these real-life examples.

First example
A 71 year old woman has surgery on her shoulder for a bone spur that is causing her considerable pain. The surgery is successful and she goes through several months of physical therapy to help her recover. But she is not recovering as expected. She continues to experience pain that radiates through her entire back. Her physical therapist does not know how to help her and attributes her failure to recover to old age. She visits her family care doctor at least twice over the next six months complaining of extreme tiredness and lack of energy. Her skin color is gray and she does not look healthy. Finally she visits her doctor and insists he check her for some problem since she is not recovering from the surgery and she feels awful. After her insistence he does a CBC blood lab and discovers she is severely anemic. He puts her in outpatient care and gives her four units of red blood cells and puts her on iron supplementation. Within two weeks the pain has disappeared and within a month she has recovered fully from the surgery. Numerous tests are done but there is no explanation for the anemia. Six months later she is healthy and active and her cheeks are ruddy. When she asks her doctor why he did not suspect anemia he tells her that she has never had anemia and based on her history he would never expect her to develop it. (He obviously has no training in geriatric care.) He then tells her, in an obvious contradiction of his previous position, that older people sometimes fail to absorb iron. Ironically, she defends the action of her doctor and does not feel he acted inappropriately.

Second example
Susan and John have been married for 46 years. Susan has always demonstrated a tendency for depression but it has generally been kept under control with medication. John's health begins to deteriorate and within a year he is dead. Several months after her husband's death, Susan is exhibiting signs of severe depression. She is given ever-increasing levels of various antidepressants but they have no effect. She is also exhibiting signs of a psychosis and is inflicting wounds upon herself. The family puts her in an assisted-living facility but they are unable to deal with their aberrant behavior. Her son who lives in New York decides to bring her to live with him and he admits her to a hospital in New York City . Tests indicate she is suffering from severe hypothyroidism and she is put on appropriate treatment. (Apparently no health practitioner had to this point suspected there may be another condition contributing to the depression other than old age.) The low thyroid undoubtedly was a significant factor in the development of her depression. But treatment of the depression is not addressed in the hospital and it has progressed considerably. She is transferred to a nursing home and wrongly diagnosed with dementia and placed in the dementia unit. She is deteriorating rapidly, she continues to abuse herself and she refuses to speak or acknowledge anyone. Within a few months she will probably be dead. At this point an experienced geriatric care physician steps forward and correctly diagnoses her condition as clinical depression. She is hospitalized for six months and undergoes aggressive treatment for depression. They also discover she is severely malnourished and correct that problem as well. She has now moved back into the home of her son. She is a normal functioning person and is even volunteering to work in the local library. The elderly health care system almost dropped the ball on this one.

Third example
A 65 year old woman, who has been active all of her life, has a small stroke which leaves her with some discomfort and pain in her right arm but does not limit her in any other way. She is anxious and nervous about her condition and the possibility of another stroke and the doctor prescribes pain pills and Valium to help her with her anxiety. Over a period of 15 years, she becomes addicted to Valium and does little else except sit in front of the TV all day long. She makes sure she maintains contact with a doctor who will provide her need for Valium. (No doctor or pharmacist would allow this abuse to go on with a younger person without intervention. Older people are often ignored and allowed their vices.) Early on, her family can see the problem and they decide to intercede. On the advice of friends they contact the geriatric care unit at a local university hospital. A geriatric care physician is alarmed at her addiction and insists they wean her off of the mood altering drug. He is willing to treat her and help her. She refuses to cooperate and in deference the family backs off. Over a period of 15 years she gets no exercise except for trips to the bathroom or trips to the living room to visit occasionally with her family. But family and grandchildren over the years visit less and less often.

After many years of sitting in the same position her knees deteriorate and she finds it difficult to walk. In order to avoid getting up from her chair to walk to the bathroom, she drinks very little fluid and becomes chronically dehydrated. This does not help her mental or physical condition. She has the joints in both knees replaced but does no exercise and the combination of the invasion of muscle tissue and lack of use of her legs causes muscles around her knees to atrophy. No follow-up is done by the orthopedic surgeon to make sure she remains active, after all she is old. She can now barely walk at all. She spends her final three years confined to one room in her daughter's house, refusing the use of a wheelchair and refusing to go anywhere beyond the bathroom.

In this case a general lack of concern by all involved demonstrates the apathy of family and the healthcare community to making sure elderly people can experience a meaningful existence in their remaining years. Had this been a younger person, say in her 40's, everyone involved would have been more aggressive in helping her solve her addiction and in making sure she had a better quality of life.

What Should You Expect At Your Age? A Lot!

Dr. Rob Stall is passionate about the area of geriatric health care. He is a board certified geriatrician and maintains a private practice as well as being medical director for a number of health care facilities. In addition to his practice, Dr Stall has a popular monthly radio program and he speaks frequently to local groups about care for the aged.

Senior-Specific ERs, Home Care Could Reduce Hospital Admissions

Hospital admissions have always been a major concern for the aging population, but the sheer numbers will make a rising problem even worse without alternatives to help take pressure away from hospitals.

With an influx of senior patients using emergency health care services, some health systems are exploring the ways in which they can improve the experience for seniors, specifically, and they’re also looking closely at care provided in the home before and after ER visits to help cut down on senior ER admissions and readmissions.

The University of California, San Diego, which operates multiple hospital campuses in greater San Diego, through grant funding of $12 million from San Diego-based West Health, is under way with plans to build a senior-specfic emergency room. It also has piloted a project to provide acute care at home. The care at home project is not restricted by age, but 90% of the patients are over age 65.

In the period of time 24 to 72 hours after a hospital admission, nurses provide care in the home such as blood draws, intravenous antibiotics administration and other medical services.

An additional layer involves encrypted text messaging between the nurse and the physician who assumes the care at home and can intervene if needed.

The Senior-Specific ER

The acute care at home project is one avenue UCSD is pursuing to improve the care process for seniors and all patients while taking some pressure away from emergency rooms. A senior-specific ER is also being designed with a similar goal in mind.

Current emergency medical facilities do not have the capacity to serve the wave of senior patients that is coming via the “silver tsunami,” said Dr. Ted Chan, chair of the Department of Emergency Medicine at UC San Diego.

“When we look at the numbers in emergency medicine, there is one emergency department visit for every two folks over the age of 65,” he said on a panel last week during MedCity’s Engage conference in San Diego. “That’s over 500 visits per 1000 people over 65… As the population grows, we imagine that will grow. It’s a significant challenge.”

There are currently around 100 emergency rooms nationwide that market themselves as geriatric ERs, Chan said, although few are taking such a comprehensive approach as UCSD’s. The university is collaborating in its research with a couple of figureheads when it comes to geriatric ERs, including Northwestern Memorial Hospital in Chicago and Mt. Sinai Hospital in New York City.

The approach to developing a senior-specific ER involves both research and data analysis, said Dr. Zia Agha chief medical officer for West Health, on the same panel.

“On the research side we are doing research with UCSD and on a national level,” he says. “We are looking at data from three EHRs. One initiative is to create a data warehouse, allowing more rapid cycle research. [We’re] also looking at using data as an opportunity to create quality measures.”

Redesigning Emergency Care

In very loose terms, a geriatric ER is one that has specific accommodations for senior patients. This could mean materials used for flooring that can help prevent falls, for example. The UCSD project, which will break ground in 2017, is also looking at a number of other elements: ample windows for natural light; ambient light that will prevent patients from becoming disoriented; acoustics and sound absorption to help patients who are hard of hearing; considerations for mobility issues including fall prevention; and ample space for caregivers in the ER, since in many cases the caregiver accompanies the patient.

But in addition to the physical aspects of the ER, training of medical staff is a major consideration. UCSD and West Health are exploring the approach of staff, including care processes and transitions.

“The first element is much more extensive screening in terms of cognitive decline,” Chan says. “We are missing opportunities to pick up on early cognitive decline.”

All nursing staff will be trained on this screening, as well as in care transitions. Post-discharge planning and communication is yet another prong of the research where opportunities lie, Chan says of an acute care at home project aimed at reducing hospital readmissions.

“If we can get [patients] home or to assisted living, but we’re not able to make it to their home, there’s [some service we can provide] from the ED that may result in some significant costs saving,” he said.

That might include nurse visits within the first 72 hours post-discharge to perform IV antibiotic administration or blood draws as in the acute care at home program. And as construction gets under way, the researchers and partner institutions will learn more about what works in the senior ER, in hopes to help address a rising issue before it becomes a problem.

“Forty-two million [seniors] in 2030 will be seen in the ER,” Chan says, citing projections. “We don’t have the resources to manage that.”

3 Myths Holding Back Aging in Place

The majority of the aging population in America, which is responsible for at least $7.1 trillion in annual economic activity, has the desire to stay in their homes, but many are hesitant to call themselves “old” or even have conversations about aging in place.

The myths and stigmas that surround these conversations are why many people are hesitant to even bring up the idea, so debunking them is the first step in opening a dialogue, according to HomeAdvisor’s Aging in Place Report 2016.

Based in Golden, Colorado, HomeAdvisor is a provider in digital home services with tools and resources for home repair, maintenance and improvement projects. The 2016 Aging in Place Report is based on the results form a survey conducted between August 10, 2016 and August 23, 2016 to 279 professional respondents and 586 homeowners 55 years and older.

A top myth among the older generation is that aging in place is about aging, the report said. This assumption can easily be debunked because aging in place is really just about livability.

Even for homeowners who are 55 and older, 40% say that they aren’t completing aging-related renovations because they don’t have physical disabilities. Though aging-related renovations are not just for homeowners with physical disabilities, Marianne Cusato, author of the report and HomeAdvisor’s housing expert, explained.

“Making homes safe and accessible for seniors is an important and primary objective of aging-in-place projects,” Cusato wrote. “Thriving in place, however, is about much more than adding grab bars and wheelchair ramps. In fact, many popular aging-in-place improvements—wider doorways, open floor plans, zero-step entrances, remote-controlled window coverings and motions-tenor lights, just to name a few—can enhance the quality of life in a home even as they make the home safer.”

Another myth believed by the 55 and older population is that aging in place is only practical in the suburbs. Among older homeowners, suburban/rural homeowners are less likely than urban homeowners to have completed or considered an aging-in-place renovation, the report said.

But what many of those homeowners may not know are the benefits of aging in place in cities. Larger cities often have better public transportation systems and increased social opportunities, which can be ideal for aging adults who may not want to drive anymore but want to maintain a social life.

Technology also brings up mixed feelings when it comes to homeowners 55 and older. Of those surveyed, 67% think smart home technology could be useful as they age, but just 19% say they have considered installing smart home technology. This could be because technology is still considered a luxury convenience instead of a necessity, Cusato pointed out.

“Older homeowners’ reluctance to adopt smart-home technology for aging in place is not surprising,” she wrote. “Older adults are less likely than younger adults to be familiar with technology in general, and smart home technology in particular is still coming into existence—and, therefore, still expensive.”

No matter what age someone is, many aging in place upgrades—such as seating in the shower, or lower cabinets—can improve quality of life, the report stresses.

“Looking at aging in place through a new lens that acknowledges how we live—not just show long we live—will usher in a new generation of home-improvement project that benefit the young, the young at heart and everyone in between,” Cusato said.

How Uber Might Soon Be Delivering Home Health Workers

The popular ride sharing company recently partnered with Circulation, a Boston-based health care transportation platform that integrates with health care systems, as well as with Uber’s API. Right now, the goal of the partnership is to provide reliable non-emergency medical transportation in Uber-driven vehicles to patients traveling to and from the hospital. But the opportunity exists to use the platform to bring health care practitioners, like home health care workers, to patients in their homes, John Brownstein, Circulation’s co-founder, told Home Health Care News.

“That would be the next phase of this platform,” Brownstein said. Brownstein, a Harvard Medical School professor and a health care adviser to Uber, has also worked with Uber on its UberHEALTH vaccine delivery platform.

Currently, transportation coordinators at hospitals use Circulation to schedule and manage affordable, on-demand rides that are tailored to patients’ specific needs, including whether that patient has a wheelchair, sensory impairment or a service animal. The HIPAA-compliant platform automatically verifies a customer’s ride eligibility and health insurance, and customers’ health and contact information is auto-populated into the platform from their health records, according to a Circulation press release.

Patients and their caregivers can also receive ride reminders and real-time notifications through text, by email or by phone, and all billing and payment reconciliation with Uber and health care organizations is dealt with on the backend of Circulation’s system.

Circulation was “designed with seniors in mind,” Brownstein said. “There’s definitely an opportunity to use Circulation for on-demand home health services,” he explained, adding that the idea is being discussed.

Circulation’s service is currently being piloted at Boston Children’s Hospital; Nemours Children’s Health System in Wilmington, Delaware; three acute-care hospitals in the Mercy Health System and an all-inclusive care program for seniors in Pennsylvania. Circulation hopes to roll out in six more states in 2016, according to the press release.

As a major push for higher minimum wages has swept the country, a new report underscores that boosting wages to $15 per hour specifically for home care workers might help strengthen the economy.

In Washington state, 34,686 state home care workers are paid through the Medicaid program and represented by the Service Employees International Union 775; increasing their minimum wage to $15 per hour would affect 81% of the state’s individual provider workforce, according to a report from The Washington State Budget & Policy Center, an organization that seeks to shape state budget decisions and discussions.

Raising the minimum wage to $15 per hour for these workers would “help workers better cover their basic needs, provide at least $180 million in annual stimulus to the state economy and create more than 800 private sector jobs in the first year of implementation,” according to the report, “How Raising Incomes for Low-Wage Workers Boosts the Economy: A Study of Washington State’s Home Care Workforce.”

Currently, hourly wages for Washington-employed home care workers don’t cover all their basic needs, according to the report. The average hourly worker in the state—78% of which are women—earns $12.82, for an average annual income of $10,540. A bump to $15 per hour would provide an additional $63 million in earnings for home care workers.

If a state law increased minimum wage to that $15 mark for Medicaid-employed workers, private pay workers would see their wages matched, according to a Washington law.

Increased wages would spur more economic activity, with a “significant increase in the purchasing power” of the affected workers, according to the report authors. The $90 million in increased wages between public and private home care workers could result in at least $180 million in total annual economic stimulus, the report says. Additionally, it could result in more than 800 private employment job opportunities.

While workers may benefit, patients and businesses could suffer as a result of higher wage pressures. One home health care company, which does not rely on Medicaid-reimbursed services, had to raise its prices so much as a result of higher wage costs, it lost an estimated 30% to 40% of its business. That business owner sought to create a new business line to make up the lost business by branching into senior living.

Last time we discussed internal factors that can increase fall risk. We wanted reinforce the importance of addressing this issue and examine external factors that can be changed to decrease fall risk.

The statistics are alarming. Seventy-eight percent of all broken bones in the elderly population are due to falls. A third of the elderly population falls at least once a year. Fifty percent of the elderly that fall and are hospitalized, never return home to independent living.

Here are some external factors that should be addressed to decrease fall risk. Please evaluate the following in your parent's home:

» make sure all walkways are clear – remove or reposition boxes, furniture, or electrical cords that may impede walkways

» install grab bars in the bathroom shower

» consider the use of a shower chair

» install handrails on both sides of a stairway

» make sure there is good lighting

» use raised toilet seats

» make sure chairs are at the proper height which will make transfers, from sitting to standing, easy

» paint the top and bottom stairs to clearly indicate where the stairs start and end

» do a walk through of frequently traveled walkways and carefully examine them for loose carpeting, uneven surfaces, or slippery surfaces

As your parent(s) approaches the "golden years", the following typically occurs:

» Reaction time declines

» Strength decreases

» Flexibility is lost

» Vision deteriorates

» Posture can change

» Disease can impair balance

» Medications may cause dizziness, fainting, etc.

» Psychological factors can increase fall risk.

It is important to talk with your doctor about these risk factors and see if he/she will provide your parent with a referral to physical therapy. At Healthcare Resources Home Health, we offer in-home Physical Therapy for our patients.

Physical therapists perform a thorough examination of your parent's neuromusculoskeletal system. Various tests include a sensory evaluation, walking tests, fear of falling tests, strength and flexibility tests, and a posture assessment to assess your parent's current status. Armed with this information, the physical therapist will create a custom program to help you and your parent achieve the desired goals. Physical Therapy will be done in the convenience of your parents home, skilled nursing facility, assisted living, or independent living- wherever the patient resides.

You and your parent may receive educational information, exercises, advice, and community resources to help decrease the risk of falling.

Make sure you give us a call to find out more at (817) 633-2273. It could be the best thing you ever do for your parents. Pass this along as well. Together, we can all decrease fall risk.

Important Facts about Falls

Each year, millions of older people—those 65 and older—fall. In fact, more than one out of four older people falls each year, but less than half tell their doctor. Falling once doubles your chances of falling again.

Falls Are Serious and Costly

One out of five falls causes a serious injury such as broken bones or a head injury.

Each year, 2.8 million older people are treated in emergency departments for fall injuries.

Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.

Each year at least 300,000 older people are hospitalized for hip fractures.

More than 95% of hip fractures are caused by falling, usually by falling sideways.

Falls are the most common cause of traumatic brain injuries (TBI).

Adjusted for inflation, the direct medical costs for fall injuries are $31 billion annually. Hospital costs account for two-thirds of the total.

What Can Happen After a Fall?

Many falls do not cause injuries. But one out of five falls does cause a serious injury such as a broken bone or a head injury. These injuries can make it hard for a person to get around, do everyday activities, or live on their own.

Falls can cause head injuries. These can be very serious, especially if the person is taking certain medicines (like blood thinners). An older person who falls and hits their head should see their doctor right away to make sure they don’t have a brain injury.

Many people who fall, even if they’re not injured, become afraid of falling. This fear may cause a person to cut down on their everyday activities. When a person is less active, they become weaker and this increases their chances of falling.

What Conditions Make You More Likely to Fall?

Research has identified many conditions that contribute to falling. These are called risk factors. Many risk factors can be changed or modified to help prevent falls. They include:

Lower body weakness

Vitamin D deficiency (that is, not enough vitamin D in your system)

Difficulties with walking and balance

Use of medicines, such as tranquilizers, sedatives, or antidepressants. Even some over-the-counter medicines can affect balance and how steady you are on your feet.

Vision problems

Foot pain or poor footwear

Home hazards or dangers such as

broken or uneven steps,

throw rugs or clutter that can be tripped over, and

no handrails along stairs or in the bathroom.

Most falls are caused by a combination of risk factors. The more risk factors a person has, the greater their chances of falling.

Healthcare providers can help cut down a person’s risk by reducing the fall risk factors listed above.

Important Facts about Falls- September is National Fall Prevention Month

Each year, millions of older people—those 65 and older—fall. In fact, more than one out of four older people falls each year, but less than half tell their doctor. Falling once doubles your chances of falling again.

Did You Know…

 1/3 of people over 65 fall annually

 The #1 reason for a MD visit for people over 75 is imbalance

 95% of hip fractures are caused by falls

 Every 15 seconds, an older adult is treated in the emergency room for a fall

 53% of adults discharged for fall related hip fractures will fall again within six months

 Fall accounts for 40% of all nursing home admissions

 1 out of 5 patients with a hip fracture die within ONE year after a fall

 Every 29 minutes, and older adult dies due to a fall

 2.3 million fall related injuries are treated in the emergency room annually

1 in 4 Home Care Workers Lives in Poverty

By Mary Kate Nelson | September 5, 2016

Taking inflation into account, American home care workers are actually making lesser wages than they did 10 years ago—despite their jobs being in greater demand than ever before. In fact, given the enormity of the upcoming demand for home care workers, this trend is unsustainable, according to a new research report.

There are about 2.2 million home care workers in the United States, and about 1 in 4 of them live below the federal poverty line, according to recently published research from the Paraprofessional Healthcare Institute (PHI). PHI is organization based in Bronx, New York, that works with care providers, consumers, policymakers and labor advocates to strengthen direct-care jobs.

Home care worker wages have not kept pace with inflation over the last 10 years, PHI’s research shows. In fact, inflation-adjusted wages stayed basically the same, and actually fell from $10.21 in 2005 to $10.11 in 2015.

Additionally, about two-thirds of home care workers work part time or for part of the year. Their employment tends to be erratic, as client care needs range from a few hours per week to around the clock, and may change with time.

Due to inconsistent hours and low wages, home care workers bring in a median annual income of $13,300. More than 50% of all home care workers depend on some kind of public assistance, the research reveals.

All of these factors combined do not make home care a necessarily attractive field for workers. But with the number of Americans over age 85 expected to triple to 19 million by 2050, the home care industry will have no choice but to attract new workers, PHI notes.

Between 2014 and 2024, home care occupations—home health aides, personal care aides and nursing assistants—are expected to add more jobs than any other single occupation, with an additional 633,100 new jobs, the research report shows.

“If the home care workforce is to grow, jobs will need to be more competitive, offering higher wages and improved working conditions,” PHI’s report concludes.

Some other findings in the report include:

Approximately 90% of home care workers are women, and their median age is 45 years old

More than half of home care workers are people of color

More than 25% of home care workers were born outside of the United States

Over 50% of home care workers have no formal education beyond high school

Editor’s Take: Documentary Focuses on Plight of Home Caregivers

Rising minimum wage levels have come to the forefront of American politics this year, with the Fight for $15 per hour taking center stage across numerous industries. Home care workers are one of those industries where on-the-ground activism has led to a big payoff—but only in some areas of the country.

For the vast majority of Americans working minimum and low-wage jobs, not much has changed. It’s a topic I report on often, but I haven’t had the opportunity to see what home care wages really look like, until I recently viewed a documentary focusing on the home care workers’ perspective. As home care workers continue to band together to push for higher wages, a recently released documentary portrays the lives and hardships of caregivers who take care of seniors at home.

The filmmakers underscore the dignity of home health care, while strongly making a point that home care workers deserve a living wage and that families should not go bankrupt to provide care to a loved one. In a word, I found the documentary heartbreaking. From the need to provide dignity and care for older Americans to the hardships faced by low-wage workers, the film attempts to expose some of the vulnerable points of the home care industry.

The documentary, Care, was funded by several groups, including ITVS, The MacArthur Foundation, The Ford Foundation and Chicken & Egg Pictures to take a deep dive into the caregiving world.

“From the time we are born, we start aging,” Ai-Jen Poo, author of Age of Dignity, co-director of Caring Across Generations and director of National Domestic Workers Alliance, says in the film. Poo advocates for better conditions and workforce protections for home care workers, emphasizing that just about everyone will need care when they are older. The average home care worker makes an average of $13,000 per year, an unsustainable salary for everyday living, Poo said.

Poo was also an advisor on the film. The film was directed by Diedre Fishel and produced by Tony Heriza, who regularly engages in media for social change.

While both consumers of home care and home health aides faced struggles related to finances, the film did offer some hope by skewing a pro-union stance from the workers’ perspective. Many home care workers depicted in the film were involved in local unions and advocacy groups working for higher wages. As a reporter who covers home health industry news with an audience made up mostly of providers and employers, I found myself much more emotional when viewing wage issues from the worker perspective. Though, the film does not give much credit to industry employers that face similar challenges related to rising wage pressures.

Shifting between four home settings, the documentary centers on the lives of home health caregivers and those with serious chronic illnesse sreceiving care in New York and Pennsylvania.

As the number of U.S. seniors continues to swell over the next decade or so, home caregivers are going to become all the more important. And yet, the fast growing workforce in the country faces some of the harshest realities and the industry could soon be facing a shortage of these much-needed caregivers.

“The fact that the fastest growing workforce earns poverty wages … is a huge problem,” Poo said in the film.

Laurie, a caregiver in McClure, Pennsylvania, said she made just over $300 per week as a caregiver to Larry, who suffered from COPD and emphysema. She doesn’t make enough to pay her rent without the help of her fiancé.

“I feel we are underpaid because … I am not thought of as a caregiver, because I’m in a home,” she said.

After taking care of Larry full time until he passed away, Laurie was unable to find a new permanent position with her home care agency, and eventually ended up working for the state of Pennsylvania doing work for roadways. Home care workers are not entitled to unemployment benefits when their patients die. While she made $5 more per hour and was entitled to full employee benefits, Laurie explained how she found the work less fulfilling and missed being a caregiver.

The effect of low wages for home care workers has the potential to upset the huge and growing demand for these workers. The best caregivers may be unwilling to stay in the profession due to the low wages, instead moving into other industries, even fast food.

“If we invest in this workforce…. they can be a huge part of the solution, managing chronic illnesses,” Poo said on a radio show, The Brian Lehrer Show, on New York’s outlet WNYC.

Around-the-clock home care for New York resident Peter decimated the family resources before the family qualified for Medicaid. However, once being on Medicaid, Peter’s wife Toni faced a new challenge in finding quality caregivers willing to stick around. Over the span of 12 months, Toni spent more on home care than she had made in the past four years, she said. Although the family was initially excited to get onto Medicaid, which would help pay for the services, they soon realized few nurses wanted to work for the low wages.

“We finally got onto Medicaid, and I thought it was fabulous news until we started using it,” Toni said in the film.

The struggle highlighted how little home care workers make and why few want to work for wages largely provided through Medicaid reimbursement.

Vilma, an undocumented home care worker who worked with 92-year old Dee, was approved for her green card during the filming of the documentary. Vilma originally started work in the U.S. cleaning homes, but moved into the high-demand industry of home care. Vilma was a strong advocate for the work she does and fighting for better wage conditions for the home care workforce.

“Every elder person has the right to have the real attention, the real care,” she said of home care.

Over all, I think the film depicts a very personal reality for many home care workers in the country. Though, many aspects of current wage laws are changing, for both employers and employees. While individual companies may struggle as wages continue to rise, the message is clear: the struggle exists on both sides.

Home health care helps older adults live independently for as long as possible, even with an illness or injury. It covers a wide range of services and can often delay the need for long-term nursing home care.

It is important to understand the difference between home health care and home care services. Although home health care may include some home care services, it is medical in nature. Home care services include chores and housecleaning, whereas home health care usually involves helping someone to recover from an illness or injury. Home health care professionals are often licensed practical nurses, therapists, or home health aides. Most of them work for home health agencies, hospitals, or public health departments licensed by the state.

Ensuring Quality Care

As with any important purchase, it is wise to talk with friends, neighbors, and your local Area Agency on Aging (AAA) to learn more about the home health care agencies in your community. Consider using the following questions to guide your search.

How long has the agency served this community?

Does the agency have a brochure describing services and costs? If so, take or download it.

Is the agency an approved Medicare provider?

Does a national accrediting body, such as the Joint Commission for the Accreditation of Healthcare Organizations, certify the quality of care?

Does the agency have a current license to practice (if required by the state)?

Does the agency offer a “Bill of Rights” that describes the rights and responsibilities of both the agency and the person receiving care?

Does the agency prepare a care plan for the patient (with input from the patient, his or her doctor, and family members)? Will the agency update the plan as necessary?

How closely do supervisors oversee care to ensure quality?

Are agency staff members available around the clock, seven days a week, if necessary?

Does the agency have a nursing supervisor available for on-call assistance at all times?

Whom does the agency call if the home health care worker cannot come when scheduled?

How does the agency ensure patient confidentiality?

How are agency caregivers hired and trained?

How does the agency screen prospective employees?

Will the agency provide a list of references for its caregivers?

What is the procedure for resolving problems, if they occur? Whom can I call with questions or complaints?

Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services?

Whether you arrange for home health care through an agency or hire an independent aide, it helps to spend time preparing the person who will provide care. Ideally, you will spend a day with the caregiver, before the job formally begins, to discuss what is involved in the daily routine. At a minimum, inform the caregiver (verbally and in writing) of the following things that he or she should know.

Health conditions, including illnesses and injuries

Signs of an emergency medical situation

General likes and dislikes

Medication, including how and when each must be taken

Need for dentures, eyeglasses, canes, walkers, hearing aids, etc.

Possible behavior problems and how best to handle them

Mobility issues (trouble walking, getting into or out of a wheelchair, etc.)

Allergies, special diets, or other nutritional needs

Therapeutic exercises with detailed instructions

A Word of Caution

Although most states require home health care agencies to perform criminal background checks on their workers and carefully screen applicants, actual regulations will vary depending on where you live. Therefore, before contacting a home health care agency, you may want to call your local area agency on aging or department of public health to learn what laws apply in your state.

Medicare pays in full for skilled nursing care, which includes services and care that can only be performed safely and effectively by a licensed nurse. Injections (and teaching patients to self-inject), tube feedings, catheter changes, observation and assessment of a patient’s condition, management and evaluation of a patient’s care plan, and wound care are examples of skilled nursing care that Medicare may cover.

Medicare pays in full for a home health aide if you require skilled services. A home health aide provides personal care services including help with bathing, using the toilet, and dressing. If you ONLY require personal care, you do NOT qualify for the Medicare home care benefit.

Skilled therapy services. Physical, speech and occupational therapy services that can only be performed safely by or under the supervision of a licensed therapist, and that are reasonable and necessary for treating your illness or injury. Physical therapy includes gait training and supervision of and training for exercises to regain movement and strength to a body area. Speech-language pathology services include exercises to regain and strengthen speech and language skills. Occupational therapy* helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes. Medicare should pay for therapy services to maintain your condition and prevent you from getting worse as long as these services require the skill or supervision of a licensed therapist, regardless of your potential to improve.

Medical social services. Medicare pays in full for services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This might include counseling or help finding resources in your community.

Medical supplies. Medicare pays in full for certain medical supplies provided by the Medicare-certified home health agency, such as wound dressings and catheters needed for your care.

Durable medical equipment. Medicare pays 80 percent of its approved amountfor certain pieces of medical equipment, such as a wheelchair or walker. You pay 20 percent coinsurance (plus up to 15 percent more if your home health agency does not accept “assignment”—accept the Medicare-approved amountfor a service as payment in full).

*If you only need occupational therapy, you will not qualify for the Medicare home health benefit. However, if you qualify for Medicare coverage of home health careon another basis, you can also get occupational therapy. When your other needs for Medicare home health end, you should still be able to get occupational therapy under the Medicare home health benefit if you still need it.

Healthcare Resource’s Home Health mission is to provide a wide range of professional, high quality health care services designed to optimize every patient’s dignity, autonomy,and comfort. We are advocates for the patient and strive to assist patients in gaining quality of life during their time of need. We are dedicated to continually seeking new ways of being responsive to the ever-changing health needs of our patients and the communities we serve.

Home health aides fill a specific and very important role in a home care plan. Certified home health aides receive training to assist with activities of daily living. They provide companionship and deliver personal care, such as help with bathing or dressing. They also can help with meal preparation and feeding, and assist you with errands or getting safely to and from appointments. A home health aide can help keep track of your symptoms and will be alert to any changes that require medical attention.

However, home health aides cannot provide medical or skilled nursing care. For example, a home health aide can remind you to take your medications on schedule and record vital signs, but they cannot dispense medications or, except under specific circumstances, check vital signs.

Your aide may assist with light housekeeping that is related to care (such as cleaning up the kitchen after feeding your loved one or tidying the bathroom after bathing and dressing), but it’s important to remember that a home health aide is not a housekeeper. Your aide’s primary responsibility is to see to your or your loved one’s well-being.

What to look for when hiring an aide

When you hire a home health aide, you should expect a person who is compassionate, trustworthy, and knowledgeable. And for peace of mind, it’s important to hire an aide who is insured, certified, and properly trained. When you’re sick, the last thing you want to do is check references or verify insurance or training credentials. Hiring an aide from a certified, licensed home care agency relieves this burden. An agency should make sure that its aides are properly trained and credentialed, that its aides have passed comprehensive background checks, and it should have the depth of staff to match you with an aide who meets your needs.

Training. A properly trained home health aide is more likely to notice changes in behavior or symptoms and act immediately and appropriately. In New York State, home health aides are trained and certified by a program approved by the New York State Department of Health. This program requires 79 hours of instruction in assistance with activities of daily living.

Compatibility. An agency is able to assess each aide’s strengths, abilities, and interests. When you call an agency, a client services representative will ask you a series of questions to understand the physical, emotional, and mental needs of the person who needs care. This will help to match you with an aide who has the skills you need, shares your interests, and is familiar with your culture, background, and even the language you’re most comfortable speaking.

About Us

Healthcare Resources Home Health is RN owned and operated with 25 years of home care experience. We practice stringent hiring processes to employ the most experienced, qualified and skilled staff available for the highest quality of patient care.

Healthcare Resources provides a broad range of comprehensive services to clients who are in need of acute rehabilitation, skilled nursing, personal care assistance and/or Medical Social Services. Home Health Services aid the clients in achieving and sustaining the highest quality of health, activity, and independence in their own home. Services are provided by experienced, trained professionals under the direction of the physician. An individualized plan of care is established for each client to provide the best combination of services required for continuity of care. Please call us at (817) 633-2273 for more information.

If you went home to visit family over the holidays, you may have noticed a change in your parents’ mental or physical condition. Perhaps your mother is more forgetful, or maybe your dad’s balance has deteriorated. You might not be sure if your loved one needs help, but you suspect that something isn’t right. How can you tell whether the changes are simply a part of aging or if they’re a sign of something more serious. Caring for a family member or loved one with healthcare issues is often overwhelming and challenging for all involved. It can sometimes be difficult to make decisions and find the answers regarding healthcare decisions. Many times you do not know where to turn for these answers and support.

When you haven't seen a loved one for a while, or even if you have, changes are scary. People are often fearful and want basic information. It's important to listen to the situation, and then try to explore every aspect.

The first step, is to determine if your parent needs medical care. The first step of a home health care company, is to go through the services offered and try to determine whether a parent needs custodial care or if there’s a need for skilled care. If there’s a medical need, we encourage callers to contact their parent’s doctor as well.

The following questions may help provide guidance in finding solutions to some of these challenges and situations. If you can answer “Yes” to any one of these questions, it may indicate that now is the time to talk with your family member/loved one’s physician about how home health care services can assist you in providing your family member/loved one with the care and assistance they may need:

Has your family member been diagnosed with any of these conditions?

Heart failure or other heart condition

Stroke

Diabetes

COPD or other respiratory condition

Alzheimer’s/Dementia/Confusion

Cancer

Have they experienced any of the following in the past three months?

Serious illness (pneumonia/infection/flu)

Joint replacement or surgery (knee/hip/shoulder/etc.)

Falls, dizziness or loss of balance

Trouble eating or swallowing

Depression

Amputation

Does your family member have difficulty keeping track of which medications they are supposed to be taking, or have they accidentally taken the wrong medication or wrong dose of medication?

Yes

No

Does your family member have difficulty performing any of the following activities?

Bathing

Getting dressed

Preparing food

Using the bathroom

Grocery shopping

Driving

Is your family member dependent on a caregiver to take him/her to doctor appointments?

Yes

No

Has the frequency of your family member’s physician visits increased or the number of times that they call the physician to deal with symptoms of their condition or side effects of their medication?

Yes

No

Is your family member on medication that makes it unsafe for him/her to leave home?

Yes

No

Is your family member’s medication changing?

Yes

No

Is your family member in need of physical therapy, speech therapy or occupational therapy?

Yes

No

Healthcare Resources Home Health has skilled staff available 24/7, to assist you and your family member/loved one in providing quality individualized care to you as we work toward your goals of recovering from your illness or injury while allowing you to remain at home.

When the times comes to select a home health agency, it is important to assess what type of service you or your loved one may need. Healthcare Resources Home Health may be the answer if you are an:

Individual who has health problems, but who wants to maintain their independence in their home with the support of a skilled clinician.

Patient who has been diagnosed with a new illness or has had a change in health status requiring changes in medication, care or treatment.

Patient who is recovering from an injury, accident or has experienced frequent falls and is in need of therapy services to help them achieve maximum functional level.

Patient who has returned home after being hospitalized for an illness and is in need of care, treatment and/or monitoring by a skilled clinician.

Patient who has complex treatments that require use of medical equipment and/or medication monitoring.

Patient who has a chronic disease and/or disability such as Alzheimer's, COPD, heart failure, kidney disease or diabetes that requires close clinical monitoring but does not want or need to enter a nursing home or skilled care facility.

Healthcare Resources Home Health is RN owned and operated with 25 years of home care experience. We practice stringent hiring processes to employ the most experienced, qualified and skilled staff available for the highest quality of patient care. Please call us at (817) 633-2273 for more information on home health services.

Healthcare Resources provides a broad range of comprehensive services to clients who are in need of acute rehabilitation, skilled nursing, personal care assistance and/or Medical Social Services. Home Health Services aid the clients in achieving and sustaining the highest quality of health, activity, and independence in their own home. Services are provided by experienced, trained professionals under the direction of the physician. An individualized plan of care is established for each client to provide the best combination of services required for continuity of care.

Muscular strength is a muscle's ability to generate force. The purpose of strength training is to increase muscle and connective tissue size, density, and toughness. Bigger muscles and stronger connective tissues are less likely to be injured. Strength training will also improve function – or the ability to get out of a chair, climb stairs, walk, and maintain balance.

STRENGTHENING MYTHS

There are many myths associated with strengthening exercise and unfortunately, they may discourage you from participating in activities that can improve your quality of life.

Myth 1 – seniors cannot improve their strength. Wrong! It is completely possible for older people to double or triple their strength in 3-4 months. Can you imagine what you could do if you were twice as strong as you are now?

Myth 2 – seniors should not do any strength training. Wrong! Seniors need strength training more than any other age group. As you age you lose strength, muscle mass, and function. The great news is that you can recover much of it. You can also improve your strength in as little as two weeks.

Myth 3 – seniors should only participate in low intensity exercise. Wrong again. There are good studies that demonstrate that exercises at higher intensities are safe and more effective. The key is that the resistance must be enough to challenge your muscles.

Myth 4 – seniors with health problems should not participate in strength training. You guessed it – wrong again! Resistance training is appropriate for seniors with many health problems and in some cases, may be preferred over aerobic exercise. It is important to consult your physician and physical therapist.

I hope you are convinced that you can and should participate in a strength training program. It is almost a sure thing that you will improve your quality of life.

To avoid injury, individualized instruction is necessary. You must use the appropriate resistance and good form to maximize benefits and avoid injury during strength training.

Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).

The goal of home health care is to treat an illness or injury. Home health care helps you get better, regain your independence, and become as self-sufficient as possible.

If you get your Medicare benefits through a Medicare health plan, check with your plan to find out how it gives your Medicare-covered home health benefits.

If you have a Medicare Supplement Insurance (Medigap) policy or other health insurance coverage, tell your doctor or other health care provider so your bills get paid correctly.

If your doctor or referring health care provider decides you need home health care, they should give you a list of agencies that serve your area, but must tell you whether their organization has a financial interest in any agency listed.

Doctor’s orders are needed to start care. Once your doctor refers you for home health services, the home health agency will schedule an appointment and come to your home to talk to you about your needs and ask you some questions about your health.

The home health agency staff will also talk to your doctor about your care and keep your doctor updated about your progress.

It’s important that home health staff see you as often as the doctor ordered.

Examples of what the home health staff should do include:

Check what you’re eating and drinking.

Check your blood pressure, temperature, heart rate, and breathing.

Check that you’re taking your prescription and other drugs and any treatments correctly.

Ask if you’re having pain.

Check your safety in the home.

Teach you about your care so you can take care of yourself.

Coordinate your care. This means they must communicate regularly with you, your doctor, and anyone else who gives you care.

Please call us for more information on home health care services at (817) 633-2273.

Skilled Observation and Assessment would be considered reasonable and necessary when a “reasonable probability exists that significant changes in the beneficiary’s medical condition may occur”. The SN would be required to evaluate the need for modification of the treatment plan, medication changes, the need for medical intervention, hospitalization etc.

Management and Evaluation of a care plan would be reasonable and necessary where underlying conditions or complications require that only a RN or PT can ensure that essential non-skilled care is achieving its purpose. The complexity of the unskilled services that are a necessary part of the medical treatment must require the involvement of a RN to promote recovery and medical safety.

Teaching and training activities which require the skills of a nurse to perform for the treatment of the patient’s acute medical condition or injury. Coverage for teaching is NOT dependent on what is being taught. The teaching itself is considered the skill and is covered by Medicare. Teaching would include, treatments, diagnosis, medications, safety in the home, safety when leaving the home, Emergency preparedness, self-care activities, bathing, preparing meals, diet’s, how to shop to be compliant with diet restrictions, HEP (home exercise programs), ROM exercises, instructions to a caregiver to assist with patient care such as transfers, ambulation, skin care, bathing, infection control, fall prevention, medications and side effects, catheter/ostomy care, wound care and any other topic as it relates to the patient’s medical needs.

Home Health Aide services are not considered billable under Medicare, however an aide can be provided as long as the patient has at least 1 qualifying skill listed above.

Many patients benefit from home health services for varous reasons. We appreciate you thinking of us when you have a potential patient. Healthcare Resources Home Health provides the most comprehensive health care to bridge the gap between hospitals, rehab centers, physicians and the patients own home. Our office is on call 24/7, which means that when a patient calls in at any time of day, they will receive an RN and not get an answering service. We service residents in Tarrant, Dallas, and Johnson counties.

Texas Senior Corps is the leading senior volunteer service partnership for solving community problems, strengthening communities, and building the capacity of nonprofit organizations in Texas. Through the component programs of Senior Corps – RSVP, Foster Grandparents, and Senior Companions – more than 22,000 Texans age 55 and older utilize their experience, skills, and talents to assist local nonprofits, public agencies, and faith-based organizations in carrying out their missions.

Texas Senior Corps volunteers have contributed over 5.8 million hours of service valued at $124,755,100. Texas Senior Corps volunteers:

Provided 1,800 frail seniors with assistance to help them live independently in their own homes and gave respite to 1,625 caregivers

Tutored or mentored more than 23,000 children and youth with special or exceptional needs

Helped more than 2,000 community organizations expand their reach and impact on community challenges

Over 20,000 RSVP volunteers currently serve through 28 projects in Texas supporting independent living for seniors, tutoring and mentoring of youth, disaster preparedness for communities, food security for individuals and families, and much more.

Over 1,500 Foster Grandparents currently serve through 17 projects in Texas supporting children and youth with special needs by providing one-on-one tutoring and mentoring.

Nearly 900 Senior Companions currently serve through 10 projects in Texas, helping homebound seniors and other adults maintain independence in their own homes.

The 55 Senior Corps projects in Texas offer nearly unlimited opportunities for volunteers to apply their lifetimes of experience to make a difference in their local communities. Contact us today to learn more about how experienced Texans can become involved in making a positive and lasting impact in their communities.

For Tarrant County- Tarrant County Senior Corps Program is who Seniors would speak to about volunteer work. Please call (817) 632-6022 for more information.

Isle at Watercrest is pleased to partner with Envoy Hospice to provide The Virtual Dementia Tour. This hands on experience is for anyone seeking to understand the physical and mental challenges of those with Alzheimer's or dementia. This unique program gives us a glimpse into the world of those with memory loss disorders. The goal of the program is to raise awareness and heighten the level of sensitivity for caring with those with dementia.

*There will be supervised care provided in a secured area for persons with dementia so caregivers can participate.

When the time arrives to seek outside home health care for your loved one, emotions and uncertainties can prevail. Thankfully, there are reputable sources of information and services available.

People often receive home services following a hospitalization or care in other care settings. Usually the hospital discharge planner or social worker provides information on area agencies. Ask the hospital for a list of home health care agencies in your community. Physicians, friends, and family can recommend agencies, as well.

Make every effort to acquire at least two references from the hospital or other sources. Also consider personal references for private caregivers or companions.

Questions to Ask Home Care Agencies

To help them select the right home health provider, the National Association for Home Care suggests asking the following questions about the agency, associated expenses and the individual professional.

How long has the agency been in business?

What are their qualifications and experience?

Is the agency licensed and bonded by the appropriate authority?

Can the agency provide references? Ask for a list of doctors, hospital discharge planners and former clients who have experience with the agency.

How does the agency protect client confidentiality?

Is the agency inspected by any outside organization? Ask for the results of the last inspection.

Does the agency perform a customer satisfaction survey? Request the results of the most recent survey.

Can the agency provide written information about the services they provide?

Can the agency provide written information about the rights and responsibilities of the providers, patients and caregivers?

Questions to Ask Professional Caregivers

How does the agency select and train care providers?

What are the credentials of the caregivers who work for the agency?

Does the agency perform criminal background checks or drug testing?

Do caregivers work directly for the agency? How are they supervised?

Do they consult the patient's physicians and family members?

Is the patient's course of treatment documented in a care plan, detailing the specific tasks to be carried out by each caregiver?

How are the family, patient and aide educated about the care to be provided?

Are nurses or therapists required to evaluate the patient's needs as they change? If so, what does this entail?

Will proper care be scheduled at any time of the day or night that my physician says is necessary?

Will the same caregiver be sent to my home for each visit?

Whom should I call with questions or complaints? How will the agency respond?

Can the agency provide me with written information about the services available?

Is there a written plan of care for each patient?

Does the agency involve the patient and caregivers in designing this plan and educate them about the care provided?

How does the agency respond to emergencies? How long is the response time?

Will the agency help me find other community services such as Meals on Wheels or homemakers services — or help find medical equipment I may need?

What is the procedure if there is not a good fit with the provider and the patient?

Questions About Home Care Costs and Payment

Many people have questions regarding how to pay for home care. Be sure you ask the agencies you speak with the following questions to find out how you can pay for the expenses you will incur:

Is the agency certified by Medicare?

Are they approved or accepted by the patient's insurance plan or supplemental insurance?

How does the agency handle expenses and billing?

Do they provide detailed explanations of all the costs associated with prescribed needs?

Remember the task at hand is to secure appropriate and compassionate care for your loved one. Though it may seem that ample time is not always given, it is wise to make the time to ask questions and arrive at the answers to your personal satisfaction. A positive experience is possible for everyone involved when you make an informed decision.

Healthcare Resources Home Health is RN owned and operated with 25 years of home care experience. We practice stringent hiring processes to employ the most experienced, qualified and skilled staff available for the highest quality of patient care.